New here- Pathology question

There is debate about whether PCa progresses from one Gleason score to another.

My personal BELIEF is that if there are more aggressive cells present then they will eventually take over. And thus Gleason will rise. So, if it rises then you have more aggressive cancer.

But that is my OPINION, not based on any study. But I do believe in logical reasoning. Level 5 PCa cells by their very nature are more aggressive.

I found this recent German study on the impact of tertiary Gleason Pattern 5 on risk of biochemical recurrence after RP. It addresses this risk by incorporating it into a quantitative model called Quantitative Gleason Grading. I don't know enough about this new grading scheme to know exactly how much impact we are talking about but it appears to be enough to worry about. My guess is that the tertiary 5 bumps you up one risk category from favorable to unfavorable intermediate risk for your planning purposes. But I dunno.

Integrating Tertiary Gleason 5 Patterns into Quantitative Gleason Grading in Prostate Biopsies and Prostatectomy Specimens.

The study's abstract said...
PATIENT SUMMARY:

Prostatectomy specimens (13 261) were analyzed to estimate the relevance of small Gleason 5 elements in prostate cancers. Even the smallest Gleason 5 areas markedly increased the risk of prostate-specific antigen recurrence after surgery. Larger fractions of Gleason 5 patterns had less further impact on prognosis. Based on this, a numerical Gleason score (integrated quantitative Gleason score) was defined by the percentages of Gleason 4 and 5 patterns, enabling a refined estimate of patient prognosis.

Thank you for your replies, good to hear that there is prob nothing to do right now.

I asked my surgeon that very question as I was upgraded post surgery from 3+4 to 4+3 with tertiary 5.

He said I might consider doing PSA check every 6 months instead of annually which is standard protocol at Johns Hopkins.

I will share the wisdom of my first oncologist who treated me for Hodgkin's Lymphoma when I asked post treatment about 5 year survival rates: "For you it is zero or 1. Stop worrying about what it is for all Hodgkin's patients and work on making your 5 year survival rate one". In other words, eat right, exercise, etc.